MRI-GUIDED LASER INTERSTITIAL THERMAL THERAPY IN MODERN NEUROSURGERY: THERMAL DOSIMETRY, PATIENT SELECTION, NEURO- ONCOLOGICAL APPLICATIONS, AND PRECISION ABLATION FOR DRUG- RESISTANT EPILEPSY

Vollständiger Abstract

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Background. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has evolved from an experimental stereotactic technique into a clinically relevant minimally invasive neurosurgical platform. Its principal advantage is the combination of stereotactic targeting, controlled thermal ablation, and real-time magnetic resonance thermometry. Contemporary indications include deep or surgically difficult gliomas, recurrent glioblastoma, progressive brain metastases after stereotactic radiosurgery, radiation necrosis, mesial temporal lobe epilepsy, hypothalamic hamartoma, and selected pediatric epileptogenic or neoplastic lesions.Materials and Methods. A structured narrative review was performed using clinical trials, prospective multicenter registries, institutional cohorts, and translational studies addressing MRgLITT in neuro-oncology and epilepsy surgery. Evidence available through August 2026 was analyzed. Particular attention was directed toward patient selection, stereotactic trajectory planning, thermal dose coverage, lesion geometry, seizure outcome, tumor control, steroid dependency, neurological morbidity, quality of life, and the emerging biological effects of thermal ablation.Results. The clinical effectiveness of MRgLITT is highly dependent on lesion geometry, anatomical location, thermal coverage, and disease phenotype. In recurrent and difficult-to-access high-grade gliomas, LITT provides cytoreduction with relatively short hospitalization and may facilitate rapid transition to adjuvant treatment. In biopsy-proven radiation necrosis, LITT can simultaneously establish tissue diagnosis and treat the responsible lesion while permitting corticosteroid reduction. For mesial temporal lobe epilepsy, prospective contemporary data indicate approximately 58% Engel class I seizure freedom at two years, although open anterior temporal resection retains higher average long-term seizure-freedom rates. Ablation of the amygdala, hippocampal head, parahippocampal region, and rhinal cortices is associated with better seizure outcomes than indiscriminate posterior extension. Hypothalamic hamartoma represents another particularly suitable indication because stereotactic disconnection can be achieved with limited surgical exposure.Conclusion. MRgLITT should not be viewed as a smaller version of open resection. It represents a distinct stereotactic therapeutic paradigm in which treatment success depends on precise target selection, three-dimensional thermal coverage, avoidance of critical neurovascular structures, and disease-specific endpoint definition. Future development will likely integrate robotic trajectory planning, connectome-informed targeting, quantitative thermal modeling, and biologically rational combinations with systemic therapy.